The Value Of Serum Tumor Markers Combined With Dynamic Detection In The Diagnosis And Prognostic Evaluation Of Primary Liver Cancer

Objective: To retrospectively analyze and compare the serum expression level of tumor markers(Tumor markers,TM),micro RNA-21(miRNA-21),Alpha-fetoprotein(AFP),Alpha-fetoprotein allosome L3(AFP-L3),and abnormal prothrombin(Des-γ-carboxy-prothrombin,DCP)in patients with primary liver cancer(Primary hepatic carcinoma,PHC)and patients with benign liver lesions,and its correlation with different clinicopathological factors in patients with PHC.And to explore the clinical application value of combined dynamic detection of serum miRNA-21,AFP,AFP-L3 and DCP in the diagnosis,condition monitoring and prognosis of PHC.Method: A total of 103 patients with PHC(PHC group)who were first diagnosed in Rizhao People’s Hospital from January 2013 to December 2015 and 50 patients with benign liver lesions who came to the hospital during the same period(benign control group)were collected as the research objects.The Serum levels of miRNA-21,AFP,AFP-L3,and DCP were detected by real-time fluorescence quantitative polymerase chain reaction,chemiluminescence and affinity centrifugation respectively.The spss23.0 statistical software was used for statistical analysis on the research data,and the measurement data are expressed by mean±standard deviation((?)±s).The measurement data between the two groups were compared by independent sample t-test,and the measurement data between multiple groups were compared by variance(F)analysis.The counting data are expressed by rate(%),and the comparison between the groups is proved by χ2 test.By comparing the levels of serum miRNA-21,AFP,AFP-L3 and DCP in the two groups and,serum levels of miRNA-21,AFP,AFP-L3,DCP in patients with primary liver cancer with different clinicopathological factors(including patient age,sex,pathogenic factors,tumor diameter,clinical stage,ascites,portal vein invasion,metastasis,recurrence and treatment),performing survival analysis using Kaplan Meier method and log rank test;and plotting the receiver operating characteristic curve(ROC)of serummiRNA-21,AFP,AFP-L3 and DCP for the diagnosis of primary liver cancer,to determine the best critical value of miRNA-21,AFP,AFP-L3 and DCP for the diagnosis of primary liver cancer.Taking pathological diagnosis as the gold standard,the clinical value of serum miRNA-21,AFP,AFP-L3 and DCP single item,partial combination and four indexes combined in the diagnosis of PHC was statistically calculated by four grid table method with P<0.05 as the difference statistically significant.Result: 1.The serum expression levels of miRNA-21,AFP,AFP-L3 and DCPin PHC patients were significantly higher than those in benign control group(t=22.440,21.233,14.990,23.091;P=0.000,0.000,0.000,0.000),P< 0.01;2.There were no significant differences in serum miRNA-21,AFP,AFP-L3,and DCP levels among patients with different ages,genders,and different pathogenic factors in the PHC group(P>0.05).The serum miRNA-21,AFP,AFP-L3 and DCP expression levels in patients with tumor diameter > 2 cm,high clinical stage,portal vein invasion,ascites,recurrence,metastasis and before treatment were significantly higher than those in patients with tumor diameter ≤ 2 cm,low clinical stage,no invasion of portal vein,no ascites,no recurrence,no metastasis and serum levels after treatment(all P<0.05);3.The 5-year event free rate in the high-level expression group of serum miRNA-21,AFP,AFP-L3 and DCP(miRNA-21>17.67,AFP>425.23ng/ml,AFP-L3>23.47 %,DCP>465.39 m AU/ml)was significantly lower than that in the low-level expression group(miRNA-21≤17.67,AFP≤425.23 ng / ml,AFP-L3≤23.47%,DCP≤465.39 m AU/ml),χ2=30.982,22.415,18.730,32.180;P=0.000,0.000,0.000,0.000.P< 0.01;4.The sensitivity,accuracy and negative predictive value of the combined detection of miRNA-21,AFP,AFP-L3 and DCP in the diagnosis of PHC were significantly improved compared with the individual detections and some combined detections(χ2=41.565,21.145,19.594;P=0.000,0.007,0.012),P< 0.05.Conclusion: Serum miRNA-21,AFP,AFP-L3 and DCP can all be used as biological indicators for the diagnosis of PHC;the combined detection of the four indicators significantly improves the sensitivity and accuracy of the diagnosis of PHC,thereby reducing misdiagnosis and missed diagnosis;dynamic detection can monitor the development of the disease and guide Clinical treatment;prognosis can be assessed based on survival curve.